Healthcare Provider Details

I. General information

NPI: 1730274143
Provider Name (Legal Business Name): COUNTY OF CRAWFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N INDUSTRIAL DR
FRONTENAC KS
66763
US

IV. Provider business mailing address

P.O.BOX 292
GIRARD KS
66743
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-3344
  • Fax:
Mailing address:
  • Phone: 620-231-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number460
License Number StateKS

VIII. Authorized Official

Name: MR. RANDY SANDBERG
Title or Position: DIRECTOR EMS
Credential: MICT
Phone: 620-231-3344